The efficacy of antivirals, corticosteroids, and monoclonal antibodies as acute COVID-19 treatments in reducing the incidence of long COVID: a systematic review and meta-analysis

Background

Whether treatment during acute COVID-19 results in protective efficacy against long COVID incidence remains unclear.

Objectives

To assess the relationship between acute COVID-19 treatments of antivirals, corticosteroids, and monoclonal antibodies (mAbs) and long COVID incidence, and their effects in different populations and individual symptoms.

Methods

A systematic review and meta-analysis.

Data sources

Searches were conducted up to January 29, 2024 in PubMed, Medline, Web of Science, and Embase.

Study eligibility criteria

Articles that reported long COVID incidence post–acute COVID with a follow-up of at least 30 days with no language restrictions.

Participants

Patients with a COVID-19 diagnosis history.

Interventions

Patients treated with antivirals, corticosteroids or mAbs.

Assessment of risk of bias

Quality assessment was based on the Newcastle-Ottawa scale, risk of bias in nonrandomized studies of interventions-I and Cochrane risk of bias tool.

Methods of data synthesis

Basic characteristics were documented for each study. Random forest model and meta-regression were used to evaluate the correlation between treatments and long COVID.

Results

Our search identified 2363 records, 32 of which were included in the qualitative synthesis and 25 included into the meta-analysis. Effect size from 14 papers investigating acute COVID-19 antiviral treatment concluded its protective efficacy against long COVID (OR, 0.61; 95% CI, 0.48–0.79; p 0.0002); however, corticosteroid (OR, 1.57; 95% CI, 0.80–3.09; p 0.1913), and mAbs treatments (OR, 0.94; 95% CI, 0.56–1.56; p 0.8012) did not generate such effect. Subsequent subgroup analysis revealed that antivirals provided stronger protection in the aged, male, unvaccinated and nondiabetic populations. Furthermore, antivirals effectively reduced 8 out of the 22 analysed long COVID symptoms.

Conclusions

Our meta-analysis determined that antivirals reduced long COVID incidence across populations and should thus be recommended for acute COVID-19 treatment. There was no relationship between mAbs treatment and long COVID, but studies should be conducted to clarify acute COVID-19 corticosteroids' potential harmful effects on the post–acute phase of COVID-19.